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Don't withhold thrombolytics from late presenters

VIEWS & REVIEWS

Although thrombolytic therapy is most effective when given early, it is likely that the benefits of late thrombolytic therapy have been underestimated. Consequently, thrombolytic therapy should not be withheld from patients presenting late (> 6h after symptom onset), according to Dr HD White.

Results from all late-treatment trials combined indicate that a significant 12% reduction in 35-day mortality is achieved by treating patients who present after 7 -12 hours, and a nonsignificant decrease in mortality occurs in patients treated after 13-24h. However, late treatment effects may have been underestimated in trials because of short-term follow-up and, possibly, investigators' tendency to treat rather than randomise suitable late-presenting patients.

Thus, Dr White concludes that thrombolytic therapy should be given: • to all patients without contraindications presenting

within 12h • to patients presenting after 12h who may benefit

most, such as the elderly or those with large infarctions, continuing pain or hypotension.

White H. Thrombolytic therapy for patients with myocardial infarction presenting after six hours. Lancet 340: 221-222, 25 lui 1992 ""1508'"

8 Aug 1992 lNPHARMA'" ISSN 0156-2703/92/0808-002/$1 .00'''' Adis International Ltd